Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 2/2017

01-02-2017 | Original Article

Outcomes After Surgery for Benign and Malignant Small Bowel Obstruction

Authors: Lauren M. Wancata, Zaid M. Abdelsattar, Pasithorn A. Suwanabol, Darrell A. Campbell Jr., Samantha Hendren

Published in: Journal of Gastrointestinal Surgery | Issue 2/2017

Login to get access

Abstract

Background

Small bowel obstruction (SBO) is a common diagnosis; however, outcomes of and risk factors for SBO and malignant bowel obstruction (MBO) surgery are not well understood. We sought to characterize outcomes and risk factors for surgery for SBO and MBO.

Methods

A retrospective cohort study was performed utilizing prospectively collected data from the Michigan Surgical Quality Collaborative (7/2012–3/2015). Cases included those with ICD9 diagnosis code of bowel obstruction and CPT codes for lysis of adhesions, intestinal bypass, and small bowel resection. Cases were stratified by disseminated malignancy (MBO). Factors associated with complications and 30-day mortality were evaluated.

Results

Two thousand two hundred thirty-three patients underwent surgery for bowel obstruction, including 86 patients (3.9 %) with MBO. MBO patients had an adjusted mortality rate of 14.5 % (benign 5.0 %); the adjusted complication rate was 32.2 % (benign 27.0 %). Factors independently associated with mortality included disseminated cancer, older age, American Society of Anesthesiologists IV/V, cirrhosis, ascites, urinary tract infection, sepsis, albumin <3.5, hematocrit <30, and bowel resection.

Conclusions

Surgery for bowel obstruction carries a relatively high risk for morbidity and mortality, particularly in patients with malignant bowel obstruction. Considering the identified risk factors for mortality may help clinicians make recommendations regarding surgery in the setting of MBO.
Literature
1.
Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg 1998;186:1–9.CrossRefPubMed
2.
Sikirica V, Bapat B, Candrilli SD, Davis KL, Wilson M, Johns A. The inpatient burden of abdominal and gynecological adhesiolysis in the US. BMC Surg 2011;doi: 10.1186/1471-2482-11-13.PubMedPubMedCentral
3.
Schraufnagel D, Rajaee S, Millham FH. How many sunsets? Timing of surgery in adhesive small bowel obstruction a study of the nationwide inpatient sample. J Trauma Acute Care Surg 2013;74:181–187.CrossRefPubMed
4.
Foster NM, McGory ML, Zingmond DS, KoCY. Small bowel obstruction: a population based appraisal. J Am Coll Surg 2006;203:170–176.CrossRefPubMed
5.
Williams SB, Greenspoon J, Young HA, Orkin BA. Small bowel obstruction: conservative vs surgical management. Dis Colon Rectum 2005;48:1140–1146.CrossRefPubMed
6.
Jafari, MD, Jafari F, Foe-Parker JE, Phelan MJ, Carmichael JC, Pigazzi A, Mills S, Stamos MJ. Adhesive small bowel obstruction in the United States: Has laparoscopy made an impact?. Am Surg 2015;81:1028–1033.PubMed
7.
Fevang BT, Fevang J, Stangeland L, Søreide O, Svanes K, Viste A. Complications and death after surgical treatment of small bowel obstruction A 35-year institutional experience. Ann Surg 2000;231:529–537.CrossRefPubMedPubMedCentral
8.
Kothari AN, Liles JL, Holmes CJ, Zapf MAC, Blackwell RH, Kliethermes S, Kuo PC, Luchette FA. “Right place at the right time” impacts outcomes for acute intestinal obstruction. Surgery 2015;158:1116–1127.CrossRefPubMedPubMedCentral
9.
ten Broek RPG, Issa Y, van Santbrink EJP, Bouvy ND, Kritwagen RFPM, Jeekel J, Bakkum EA, Rovers MM, van Goor H. Burden of adhesions in abdominal and pelvic surgery: Systematic review and met-analysis. BMJ 2013;347.
10.
Anthony T, Baron T, Mercandante S, Green S, Chi D, Cunningham J, Herbst A, Smart E, Krouse RS. Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction. J Pain Symptom Manage 2007;34:S49-59.CrossRefPubMed
11.
Alses OB, Kim S, Chen Z, Owonikoko TK, El-Rayes BF. Management patterns and predictors of mortality among US patients with cancer hospitalized for malignant bowel obstruction. Cancer 2015;121:1772–1778.CrossRef
12.
Dalal KM, Gollub MJ, Miner TJ, Wong WD, Geredes H, Schattner MA, Jaques DP, Temple LK. Management of patients with malignant bowel obstruction and stage IV colorectal cancer. J Palliat Med 2011;14:822–828.CrossRefPubMed
13.
Paul Olson TJ, Pinkerton C, Brasel KJ, Schwarze ML. Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg 2014;149:383–392.CrossRefPubMedPubMedCentral
14.
Winner M, Mooney SJ, Hershman DL, Feingold DL, Allendorf JD, Wright JD, Neugut AI. Management and outcomes of bowel obstruction in patients with stage IV colon cancer: a population based cohort study. Dis Colon Rectum 2013;56:834–843.CrossRefPubMedPubMedCentral
15.
Miller G, Boman J, Shrier I, Gordon PH. Small-bowel obstruction secondary to malignant disease: an 11 year audit. Can J Surg 2000;43:353–358.PubMedPubMedCentral
16.
17.
Miner TJ, Brennan MF, Jaques DP. A prospective, symptom related, outcomes analysis of 1022 palliative procedures in advanced cancer. Ann Surg 2004;204:719–726.
18.
Badgwell BD, Smith K, Liu P, Bruera E, Curley SA, Cormier JN. Indicators of surgery and survival in oncology inpatients requiring surgical evaluation for palliation. Support Care Cancer 2009;17:727–734.CrossRefPubMed
19.
Krouse RS, Nelson RA, Farrell BR, Grube B, Juarez G, Wagman LD, Chu DZ. Surgical palliation at a cancer center: incidence and outcomes. Arch Surg 2001;136:773–778.CrossRefPubMed
20.
Tseng WH, Yang X, Wang H, Martinez SR, Chen SL, Meyers FJ, Bold RJ, Canter RJ. Nomogram to predict risk of 30-day morbidity and mortality for patients with disseminated malignancy undergoing surgical intervention. Ann Surg 2011;254:333–338.CrossRefPubMed
21.
Campbell DA Jr, Englesbe MJ, Kubus JJ, Philips LR, Shanley CJ, Velanovich V, Lloyd LR, Hutton MC, Arneson WA, Share DA. Accelerating the pace of surgical quality improvement: the power of hospital collaboration. Arch Surg 2010;145:985–991.CrossRefPubMed
22.
Chu DI, Gainsbury ML, Howard LA, Stucchi AF, Becker JM. Early versus late adhesiolysis for adhesive-related intestinal obstruction: A nationwide analysis of inpatient outcomes. J Gastrointest Surg 2013;17:288–297.CrossRefPubMed
23.
Teixeira PG, Karamanos E, Talving P, Inaba K, Lam L, Demetriades D. Early operation is associated with survival benefit for patients with adhesive bowel obstruction. Ann Surg 2013;258:459–465.CrossRefPubMed
24.
Maung AA, Johnson DC, Piper GL, Barbosa RR, Rowell SE, Bokhari F, Collins JN, Gordon JR, Ra JH, Kerwin AJ, Eastern Association for the Surgery of Trauma. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012;73:S362–369.
25.
Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C, Fraga GP, Kelly MD, Moore FA, Mandalá V, Mandalá S, Masetti M, Jovine E, Pinna AD, Peitzman AB, Leppaniemi A, Sugarbaker PH, Goor HV, Moore EE, Jeekel J, Catena F. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the would society of emergency surgery ASBO working group. World J Emerg Surg 2013;8(1):42. doi:10.​1186/​1749-7922-8-42.
26.
Diaz, JJ, Bokhari, F, Mowery NT, Acosta JA, Block EFJ, Bromberg WJ, Collier BR, Cullinane DC, Dwyer KM, Griffen MM, Mayberry JC, Jerome R. Guidelines for management of small bowel obstruction. J Trauma 2008;64:1651–1664. 
27.
Chakraborty A, Selby D, Gardiner K, Myers J, Moravan V, Wright F. Malignant bowel obstruction: Natural history of a heterogeneous patient population followed prospectively over two years. J Pain Symptom Mange 2011;41:412–420.CrossRef
28.
Shariat-Madar B, Jayakrishnan TT, Gamblin C, Turaga KK. Surgical Management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol 2014;110:666–669.CrossRefPubMed
29.
Amikura K, Sakamoto H, Yatsuoka T, Kawashima Y, Nishimura Y, Tanaka Y. Surgical management for a malignant bowel obstruction with recurrent gastrointestinal carcinoma. J Surg Oncol 2010;101:228–232.PubMed
30.
Henry JC, Pouly S, Sullivan R, Sharif S, Klemanski D, Abdel-Misih S, Arradaza N, Jarjoura D, Schmidt C, Bloomston M. A scoring system for the prognosis and treatment of malignant bowel obstruction. Surgery 2012;152:747–757.
31.
Cauley CE, Panizales MT, Reznor G, Haynes AB, Havens JM, Kelley E, Mosenthal AC, Cooper Z. Outcomes after emergency abdominal surgery in patients with advanced cancer: Opportunities to reduce complications and improve palliative care. J Trauma Acute Care Surg 2015;79:399–406.
32.
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733–742.
33.
Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer 2008;44:1105–1115.CrossRefPubMed
34.
Ferguson HJ, Ferguson CI, Speakman J, Ismail T. Management of intestinal obstruction in advanced malignancy. Ann Med Surg (Lond) 2015;4:264–270.
35.
Krouse RS and You YN. Prospective comparative effectiveness trial for malignant bowel obstruction: SWOG S1316. Bull Am Coll Surg 2015;100:49–50.PubMed
Metadata
Title
Outcomes After Surgery for Benign and Malignant Small Bowel Obstruction
Authors
Lauren M. Wancata
Zaid M. Abdelsattar
Pasithorn A. Suwanabol
Darrell A. Campbell Jr.
Samantha Hendren
Publication date
01-02-2017
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 2/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3307-8

Other articles of this Issue 2/2017

Journal of Gastrointestinal Surgery 2/2017 Go to the issue

Original Article

Comparative Study Between Trans-perineal Repair With or Without Limited Internal Sphincterotomy in the Treatment of Type I Anterior Rectocele: a Randomized Controlled Trial

Letter to the Editor

Comment on: Preoperative Sarcopenia Strongly Influences the Risk of Postoperative Pancreatic Fistula Formation After Pancreaticoduodenectomy

Original Article

The Impact of Advancing Age on Recurrence and Survival Following Major Hepatectomy for Colorectal Liver Metastases

Original Article

Circumportal Pancreas—a Must Know Pancreatic Anomaly for the Pancreatic Surgeon

Review Article

Surgical Considerations in the Treatment of Small Bowel Crohn’s Disease

GI Image

Primary Castleman’s Disease of the Liver